5.2 White blood cells

Question 1

Name the 5 major types of leukocyte.

Answer 1

• Neutrophil
• Lymphocyte
• Monocyte
• Basophil
• Eosinophil

(Not exhaustive)

Question 2

What factors can affect the outcome of an FBC?

Answer 2

• Age (newborns have higher lymphocyte count than adults)
• Ethnicity
• Analyser used

Question 3

What do leukocytes develop from?

Answer 3

Pluripotent stem cells -> CFU-GEMM -> cell types

Question 4

Describe neutrophils.

Answer 4

• Distinct
• Well granulated, granules contain enzymes
• 3-5 lobed nucelus
• 12-15um diameter
• Spend 10 hours in circulation before moving to tissue where they survive for 4-5 days
• Deal primarily with bacteria and fungi

Question 5

Describe monocytes.

Answer 5

• Large cells
• Blueish cytoplasm
• Large nucleus
• Migrate to inflamed and infected tissues
• Become macrophages when they reach tissues
• Present antigens to lymphocytes

Question 5

Describe lymphocytes.

Answer 5

• Pale agranular cytoplasm
• Large nucleus, dense chromatin
• 6-10um diameter
• Deal with viruses
• 2 different lineages: T and B cells

Question 6

Describe basophils.

Answer 6

• Heavily granulated cytoplasm
• Release histamine
• Large irregular nuclei

Question 7

Describe eosinophils.

Answer 7

• Distinct pink cytoplasm
• Granulated
• Multi-lobed nucleus (similair to neutrophil but more heavily granulated)
• Mediate hypersensitivity reactions primarily to parasites and allergerns

Question 8

What 2 divisions of leukaemia are there?

Answer 8

• Acute
• Chronic

Question 9

Name 2 forms of acute leukaemia.

Answer 9

• Lymphoblastic
• Acute myeloid

Question 10

Name 3 forms of chronic leukaemia.

Answer 10

• Lymhpocytic
• Chronic myeloid
• Myelo-monocytic

Question 11

Describe the typical demographic of patients with acute leukaemia.

Answer 11

• Peak incidence in 7th decade
• 2-3 per 100 000 per annum in children
• 15 per 100 000 per annum in adults

Rare

Question 12

What symtpoms may a patient with acute leukaemia present with?

Answer 12

• Lethargy
• Bleeding
• Gingival hypertrophy
• Infections
• Mouth ulcers
• Lymphadenopathy

Question 13

Which acute leukaemia type causes bleeding, nosebleeds, bleeding gums and haemorrhage?

Answer 13

M3 acute promyelocytic leukaemia

Question 14

Which acute leukaemia types can cause gingival hypertrophy?

Answer 14

M4 and M5.

Question 15

How is acute leukaemeia diagnosed?

Answer 15

FBC, blood film, bone marrow tests

Question 16

Describe acute lymphoblastic leukaemia.

Answer 16

• Most common childhood malignancy
• Has many subtypes
• Signs and symptoms: bleeding, infection, lymphadenopathy, other organ involvement
• Treatment involves chemotherapy and an allogeneic BM transplant for adults
• Susceptible to oral thrush and bacterial infections
• Good prognosis in children (over 90%)
• Survival rate decreases with age

Question 17

How is acute myeloid leukaemia treated?

Answer 17

• 3-4 cycles of intensive inpatient chemotherapy
• Allogeneic bone marrow transplant for intermediate and high risk groups

Question 18

Describe chronic lymphocytic leukaemia.

Answer 18

• Common in older patients
• Weight loss, night sweats, lymphadenopathy, splenomegaly

Question 19

Describe chronic myeloid leukaemia.

Answer 19

• Raised WBC count
• Median pt age of 50-60
• Lethargy, weight loss, blurred vision, headaches, splenomegaly
• Treated with tyrosine kinase inhibitors to block cancer growth

Question 20

What types of lymphoma are there?

Answer 20

• Non-Hodgkin’s: T or B cell
• Hodgkin’s: classical and non-classical

Question 21

Describe the presentation of lymphoma.

Answer 21

Variable presentation.
- Lymphadenopathy
- Classic B symptoms: weight loss, night sweats and lethargy

Question 22

What are the differential diagnoses for lymphoma?

Answer 22

• Different cancer type e.g. oral cancer
• Infection e.g. severe dental abscess, tuberculosis, sarcoidosis

Question 23

What is the peak age for lymphoma?

Answer 23

20-29

Question 24

How is lymphoma diagnosed?

Answer 24

- Thorough history - Biopsy of lymph node/mass (within 6 weeks) - CT thorax, abdomen and pelvis - Bone marrow required for staging of cancer

Question 25

How is Non-Hodgkin's lymphoma treated?

Answer 25

- IV chemo - Oral chemotherapy for low grade cancer - Radiotherapy for local disease control - Autologous stem cell transplant for relapsed aggressive types

Question 26

How is Hodgkin's lymphoma treated?

Answer 26

- IV chemo +/- radiotherapy - Autologous translpant if relapsed or refractory disease - Allogeneic transplant in select patients with multiple relapse

Question 27

Describe myeloma.

Answer 27

- B-cell cancer - Malignant plasma cell disorder - Incurable - Characterised by presence of a paraprotein or abnormal light chain and end organ damage - Median age at diagnosis: 65

Question 28

How is myeloma diagnosed?

Answer 28

- FBC - Renal function - Calcium - Serum electrophoresis for paraprotein - Urine electrophoresis for Bence Jones protein - Skeletal survey - Bone marrow examination - CT skull shows raindrop appearance (small circles of bone loss)

Question 29

How is myeloma treated?

Answer 29

Chemotherapy and bisphosphonates (ONJ risk). Autologous bone marrow transplant used in pts under 70 with minimal/no comorbidities.

Question 30

What is ONJ?

Answer 30

Osteonecrosis of the jaw. Exposed bone in maxillofacial region for more than 8 weeks in the absence of radiotherapy.

Question 31

What are myelodysplastic syndromes?

Answer 31

- Group of cancers in which immature blood cells in the bone marrow do not mature or become healthy blood cells - Acquired bone marrow failure - Increasing incidence with age - Only cure is allogeneic transplantation - Supportive care with blood products and GFs - Some chemotherapy drugs may be suitable for some patients